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Spinal infection--an overview and the results of treatment
1Department of Orthopaedics and Traumatology, Hospital Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur.
Abstract:
A retrospective review of thirty-eight patients (16 males and 22 females) with spinal infection between 1993 and 1998 revealed that the mean age was 39.9 years and the peak incidence was in the 5th decade of life. Infections in thirty-two patients (84.2%) were tuberculous in origin, 13.2% were pyogenic and 2.6% were fungal. Back pain was a symptom in 94.7% while 55.8% had neurological deficits, of which two-thirds were tuberculous in origin. Twenty-two patients (57.9%) had an impaired immune status secondary to pulmonary either tuberculosis, diabetes mellitus, intravenous drug abuse, prolonged steroid treatment, malnutrition, or advanced age. History of contact with tuberculous patients was elicited in 31.3%, extraskeletal tuberculosis was found in 28.1%, while Mantoux test was only positive in 53.1% of tuberculous patients. Majority of the cases (57.9%) involved lumbar vertebra. The histopathological examination was only positive in 22.2% from material taken via CT guided biopsy but 93.3% were found to be conclusive from open biopsy. 4 out of 5 patients who had a pyogenic infection were treated conservatively and produced a good result. There was no difference in outcome for tuberculosis patients treated with either the 3 drug or 4 drug regimen. Anterior decompression and bone grafting in tuberculous patients was superior in terms of a faster fusion rate, early pain relief and prevention of kvphotic deformity. The initial neurological deficit did not reflect the future prognosis of patients with spinal infection.
Insights
Spinal infections are predominantly tuberculous, often affecting the lumbar spine and presenting with back pain and neurological deficits. Surgical intervention like anterior decompression and bone grafting offers superior outcomes for tuberculous spinal infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Neurosurgery
Background:
- Spinal infections pose significant diagnostic and therapeutic challenges.
- Tuberculosis is a major cause of spinal infections, particularly in certain populations.
- Understanding the epidemiology and outcomes of spinal infections is crucial for effective management.
Purpose of the Study:
- To analyze the clinical characteristics, causative agents, and treatment outcomes of spinal infections.
- To compare the efficacy of different diagnostic methods and treatment strategies.
- To identify factors influencing prognosis in patients with spinal infections.
Main Methods:
- Retrospective review of 38 patients with spinal infection (1993-1998).
- Data collection included patient demographics, clinical presentation, microbiological and histopathological findings, imaging, and treatment outcomes.
- Comparison of conservative vs. surgical management and different drug regimens.
Main Results:
- Tuberculous infections accounted for 84.2% of cases, followed by pyogenic (13.2%) and fungal (2.6%).
- Common symptoms included back pain (94.7%) and neurological deficits (55.8%).
- CT-guided biopsy had lower diagnostic yield (22.2%) compared to open biopsy (93.3%).
- Anterior decompression and bone grafting showed superior results in tuberculous cases.
- Conservative treatment yielded good results for pyogenic infections.
Conclusions:
- Tuberculous spinal infection is prevalent, often associated with impaired immune status and extraskeletal involvement.
- Open biopsy is more reliable for histopathological diagnosis.
- Surgical management, particularly anterior decompression and bone grafting, is advantageous for tuberculous spinal infections.
- Initial neurological deficit does not predict long-term prognosis.